In general, laparoscopic surgery, unlike conventional open surgical procedures, refers to a surgical technique where four to six incisions about 0.5˜1.2 cm in size are made in the patient's abdomen, and trocars, which have a diameter of 0.5˜1.2 cm and are 15˜16 cm long, are placed through these incisions. A light source, a camera, and surgical instruments are then introduced into the abdomen through the trocars. The surgeon performs the procedure, watching a television monitor to which the camera transmits an image of the organs inside the abdomen.
For laparoscopic surgery, after a plurality of trocars is placed into a patient's abdomen, carbon dioxide gas is used to inflate the abdomen through one of the trocars in order to give the surgical space to work. The endoscope and surgical instruments are then introduced through other trocars. The surgeon performs a surgery for the affected area, monitoring the surgical site.
After the procedure, in order to close the incisions, a trocar site closure tool is used. The trocar site closure tool is configured such that the incisions are closed by stitching while the needle is held by the forceps that are placed into the abdominal cavity through the trocar. After closing the incisions, in order to prevent the stitches from being untied, opposite ends of the surgical suture are pulled out of the patient's body through the trocar, and the knots are tied outside the patient's body. After tying the knots, the knots are formed into the abdominal cavity by pushing the knots using a compressor.
After the surgical site inside the abdominal cavity is treated, the trocar is removed and the port is closed.
Port closure can be done by direct suturing or by using a closure device.
According to a conventional art, the perforation of the port by the trocar secures the operative pathway, and the closure of the port by the closure device is performed by using a separate device.
As shown in FIG. 1, a trocar is used to form a surgical port site, the trocar 10 includes: a tubular sleeve 14 with a penetrating tip 16 penetrating therethrough; and a handle 12 provided at an upper portion of the sleeve, wherein an end of the penetrating tip 16 is constituted by a pointed end 16a to penetrate through subcutaneous tissue of an abdominal cavity, whereby after perforating a port, the penetrating tip is removed, various surgical tools are introduced through the trocar 10 to perform surgery.
After the surgery, the trocar 10 is removed and the port is closed by using a closure device as shown in FIG. 2.
The closure device shown in FIG. 2 is well known to those skilled in the art, and the use thereof is gradually increasing since it provides safety allowing rapid closure of the port without failure.
The closure device is also known as a fascial closure device.
The fascial closure device, which is in a tube shape for being introduced into a port site, includes: a tubular body 21 formed with guide groove 22 that face each other and guide insertion of a needle 23; and a pair of wings 25 being mounted to a lower portion of the tubular body, and being opened and closed using cam method, wherein each of the wings is provided with a silicon pad 26 at a location where the needle 23 penetrates through, and the wings 25 are configured to be opened by rotating an operating stick 24 and configured to be closed by reversely rotating the operating stick 4.
The inventor of the present invention filed the document a laparoscopic port site closure device, which has a new structure that improves disadvantages of a conventional closure device, and it is registered as Korean Patent No. 1594082.
According to the above document of the inventor, the laparoscopic port site closure device is configured such that a cartridge receiving a surgical suture therein is provided at a fore-end of a needle guide for port site closure; the surgical suture is caught in a needle tip that is pierced through a body tissue by being guided by the needle guide; and when the needle is withdrawn, the surgical suture is pulled out along a path through which the needle is pierced into the tissue, and the surgical suture is tied outside a patient's body, thereby being capable of closing a laparoscopic port site. The closure device includes: a tubular body provided with needle guides that face each other and guide insertion of a needle; wings mounted to a lower portion of the tubular body such that the wings are opened and closed through a cam method; and an operating stick penetrating through the tubular body to operate the wings by being rotated to push and open the wings and to pull and close the wings by being rotated reversely, wherein a replaceable cartridge is provided on a lower end of the tubular body to be detachably combined with the operating stick, and the cartridge is provided with the wings capable of being opened by operating the operating stick, and provided with a compartment for receiving surgical suture therein, whereby opposites ends of the surgical suture in the compartment are threaded through the wings such that the ends of the surgical suture are pulled out of a patient's body by being caught by a suture slot of a needle that is pierced into the patient's body from outside.
According to the inventor's document of the prior patent, the cartridge receiving a surgical suture therein is replaceable, whereby the port site can be easily closed without failure, and the closure device is reusable by replacing the cartridge receiving the surgical suture therein. However, since the conventional closure device including the prior patent is limited to a closure device that simply closes an opened port, port opening and port closure are performed through different devices.
Since opening and closure are performed by different devices, when the fascial closure device (the closure device) is introduced through the port site after removing the trocar to after surgery, the gas injected inside the abdominal cavity overly escapes, whereby the surgical space narrows so it is difficult to perform a follow-up treatment, the operation time may be long due to removal of the trocar and the replacement of the fascial closure device, which is an obstacle to the patient's prognosis.